TOPIC 28 & 29: APM VS PM & GREIVOUS INJURY FORENSIC MEDICINE 1

TOPIC 28 : APM VS PM The difference between AM and PM wounds.

274. In a Anti-mortem burn which is NOT true FEATURES AM WOUND PM WOUND

A. Line of redness • Edges Swollen, laceracted and wound Doesn't gape
GAPES
B. Increase in enzymes
• Hacmoirhagc Abundant, usually arterial Slight and venous
C. Vesicle formation
• Spurting Signs of spurting of arterial No spurting, oozing of
D. Nonalbuminus bulla blood blood
D • Extravasation Staining of wound edge Stain can be removed
..........(AIIMS PGMEE JUNE - 1999) Extravasation, sums cannot be by washing
removed by washing

Difference between Antemortem burns & post mortem burns • Coagulation In wound, linn clot No clotting or solt clot

Antemortem burns Post • Vital reaction Present (Inflammation + repair) Absent

• Enzyme Increased activity of, Diminished or no
mortem burns esterase, adenosine enzyme activity
Line of redness Present Absent triphosphate, acid and
Vesicles Contain albuminous fluid Contain Air & alkaline phosphatase
chloride
TOPIC 29 : GREIVOUS INJURY
Infection Pus and sloughing Nil
Healing Granulation Nil
279. Which of the following are grevious injury :
Soot in upper resp. tract Present Absent
A. Emasculation
Carboxyhaemoglobin in blood Present
B. Privation of any member of joint.
Absent
Enzymes Increase in enzymes No s uch C. Permanent disfiguration of head or face.
increase D. Injury that heals spontaneously without any damage
• Apart from these differences: E. Injury causing an absence from work for 15 days
• Finding particles of soot in the air passage and stomach. C
• And cherry red colour of blood due to presence of CO are ...........(PGI - DEC 2003)
sure signs of death from burning.
280. Injury that comes under sec 320 IPC
A. Abrasion over face
B. Nasal bone fracture
C. Epistaxis
D. Lacerated wound over scalp
B
..........(PGI - JUNE 1997)

281. Which of these is not a grevious injury?

275. Differ ence between antemor tem burns & A. Loss of teeth
postmortem burns vesicles, favouring AM burn B. Loss of hearing of one ear
vesicles is/are : C. Permanent disfiguration of face.
A. Tissue beneath vesicle is dry, hard & yellow D. Abrasion on face
B. Protein & chlorides in vesicle are more D
C. Erythema is present ...........(AIIMS PGMEE - NOV 2007)
D. Fluid in the vesicle is scanty
B and C
Grevious injury
..........(PGI - 2000 - Dec)
Section 320IPC defines following injuries as grevious injury:
276. Difference between antcmortcm & postmortem 1. Emasculation (cutting of the penis, castration, or causing
blisters : loss of power of erection due to spinal injury).
A. Size 2. Permanent privation of the sight of either eye.
B. Colour of the blister fluid 3. Permanent privation of the hearing of either ear.
C. Chloride and albumin content 4. Privation of any member (part, organ, limb) or joint.
D. PM blister is dry 5. Destruction of permanent impairing of powers of any
C member or joint.
..........(PGI - JUNE 2005). PGI - June -1998 6. Permanent disfiguration of head or face.
7. Fracture or dislocation of a bone or a tooth.
278. Difference between antemortem wounds and
postmortem wounds, in favour of AM wounds is/
8. Any hurt which endangers life, or which causes the sufferer
are:
A. Are larger to be, during the space of twenty days, in severe bodily
B. Increased gaping of wounds pain, or unable to follow his daily routine.
C. Increased enzyme activity Section 319 IPC defines hurt as bodily pain, disease, or
D. Oozing of blood infirmity, caused to any person.
B and C [Note that a simple stay in hospital for 20 days does not
..........(PGI - June -2001) constitute griveous injury]

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 TOPIC 30 & 31: GRIEVOUS HURT & GUN POWDER FORENSIC MEDICINE 2

Simple injury TOPIC 31 : GUN POWDER

A simple injury is one which is neither extensive nor serious, 284. All are components of gun-powder EXCEPT
and which would heal rapidly without leaving any A. Charcoal
permanent deformity or disfiguration. B. Lead peroxide
C. Potassium nitrate
TOPIC 30 : GRIEVOUS HURT D. Sulphur
B
282. A 25 year old person sustained injury in right eye. ..........(AIIMS PGMEE - SEP 1996), AIIMS PGMEE - FEB –
He developed right corneal opacity following the 1997, PGI - DEC 2006, PGI - June -2002
injury. Left eye was already having poor vision. • Black gun powder consists of:
Corneoplasty of right eye was done and vision was – Charcoal (15%)
restored Medicolegally such injury is labelled as : – Sulphur (10%)
A. Grievous – Potassium nitrate (75%)
B. Simple • Smokeless powder* contains nitrocellulose or sometimes
C. Dangerous nitroglycerine in addition.
D. Serious
A
..........(AIPGMEE - 2004)

Grevious injury :
Grevious injury is defined as one :
1. Which is extensive or serious
2. Which does not heal rapidly
3. Which causes a permanent deformity or disfiguration.
Sector 320 IPC defines following injuries as grievous :
A Emasculation
Permanent privation of the sight of either eve
Permanent privation of the hearing of either eye
Privation of any member (part, organ, limb) or joint
Destructive ‘or’ permanent impairing of powers of any member 288. Gunshot residue on hands can be detected by -
or joint A. Phenolphthalein test
B. Dermal nitrate test
Fracture or dislocation of a bone or a tooth. C. Benzidine test
Permanent disfiguration of head or face D. Hydrogen activation analysis
Any hurt which endangers life, which causes the sufferer to B
be, during the space of twenty days: in severe body pain, ..........(AIIMS PGMEE - NOV 2005)
or unable to follow his daily routine. Dermal nitrate test (paraffin test)
The injury to the patient in question should be termed • This test was in vogue earlier to determine if a suspect
erievous because : The patient developed corneal opacity had discharged a firearm.
following injury in the only working eye. This corneal opacity • The blow black powder residues gets deposited on the
is unlikely to heal (criterion in the definition) and also this back of the palm and web of the alleged firer’s hands.
man would have not been able to perform his daily routine • These residues on the firer’s hands were collected on
because he was blinded by the injury and loss would have paraffin cast and tested for nitrate usine diphenvlamine
been permanent if the disease is allowed to follow the reagent.
natural course of events. (No surgical intervention is done).
Simple injury is one which is neither extensive nor serious
and which would heal rapidly without leaving any
permanent deformity or disfiguration

• A dangerous injury is a variety of grievous injury. It is an

injury, which poses an immediate danger to life. It is either
extensive or serious in relation to the organ or part
wounded. The injury is fatal in the absence of surgical
aid. Common examples of such injuries are gunshot
wounds, compound fractures of the skull, transection of
a large or important blood vessel, and rupture of some
internal organ, e.g. Spleen.

283. Grevious injuries are :

A. Severe bodily pain for 10 days
B. Not able to work for 17 days
C. Dislocation of tooth
D. Joint dislocation
E. Bone fracture
C,D and E
..........(PGI - 2000 - Dec)

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 TOPIC 32: IUD FORENSIC MEDICINE 3

This test is now obsolete as it is given by common oxidising
substances and non-incriminating materials like fertilisers,
cigarettes, urine etc.
• Better chemical tests for nitrates and GSRS (antimony,
barium, copper, lead) are now used to examine hand
swabs/ washings.
• The modern instrumental methods used for this purpose
are -
- Neutron activation analysis (not hydrogen activation
analysis)
- Atomic absorption spectrophotometry
- Scanning electron microscopy with X-ray analyser
TOPIC 32 : IUD
• Dead born child
- a dead born child is one which has died in utero, and
shows one of the following signs
1) Rigor mortis at delivery
2) Maceration
- This is the process of aseptic autolysis of the fetus dead
in utero and is the usual change
- It occurs when the dead fetus remains in the uterus for
3-4 days surrounded by liquor amnii but with the exclusion
of air.
- It does not occur if the dead fetus is born within about
24 hrs.
- It is characterised by softening and degeneration of
tissues.

289. Spalding’s sign occurs after: - The process is aseptic because the fetus is enclosed in
A. Birth of live fetus the membranes in a sterile condition.
B. Death of fetus in uterus • Signs of maceration are
C. Rigor mortis of infant - The earliest sign of maceration is skin slippage which can
D. Cadaveric spasm be seen in 12 hrs after the death of the child in utero.
B - Appearance of gas in heart and great vessels (Robert’s
..........(AIPGMEE - 2006). PGI - June -2001 sign)
“Spalding’s sign is indicative of the death of the fetus
& its consequent maceration in utero”.
Spalding’s Sign is a radiological sign produced by partly
overriding skull bones. It may be consequent to
intrauterine maceration of fetus and its presence is a sign
of death of fetus in utero.
- Spalding Sign:
• it is radiological sign (by X-Ray)
• Due to skull bones overriding each other
• Can diagnose fetal death in utero

290. False Negative Hydrostatic test in a live born foetus

may be seen in:
Collapse of vertebral column
A. Atelectasis
- The body of the macerated fetus, is soft, flaccid and
B. Artificial Respiration
flattens out when placed on a level surface.
C. Emphysema
- It has sweetish disagreeable odour.
D. Putrefaction
- The skin is red or purple
A
- Large blebs appear at 24 hrs which contains thin fluid
..........(AIPGMEE - 2008)
• This is anencephaly. This condition occurs when there is
291. Spalding sign is seen in
failure of formation of the fetal cranial vault. The brain
A. Drowning
cannot form properly when exposed to amniotic
B. Maceration
fluid.
C. Mummification
• Note that this fetus died in utero—there are signs of
D. Starvation
maceration, with skin slippage and reddening.
B
..........(AIPGMEE - 2007), AIIMS PGMEE - MAY 2007

“Spalding’s sign is indicative of the death of the fetus

& its consequent maceration in utero”.
Spalding’s Sign is a radiological sign produced by partly
overriding skull bones. It may be consequent to
intrauterine maceration of fetus and its presence is a sign
of death of fetus in utero.
- Spatding Sign:
• It is radiological sign (by X-ray)
• Due to skull bones overriding each other
• Can diagnose fetal death in utero
• Seen in maceration
It appears by 7 days after death.
— Robert’s sign : as early as 12 hrs. it is gas shadow in
chambers and great vessels of heart. - The epidermis detaches easily and leaves moist and greasy
— Hyperflexion of spine. areas.
Crowding of ribs shadow with loss of normal parallelism. - The umblical cord is thickened and soft

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 TOPIC 33: OPIOID POISONING FORENSIC MEDICINE 4

- The bony junctions both in the skull and in this joints are C. Rhinorhea
lax and abnormally mobile. D. increased Blood pressure
- Spalding sign is seen C
• If the membranes are ruptured after the death of the ..........(AIPGMEE - 2002)
fetus and air enters into liquor amnii, the fetus undergoes
putrefaction instead of maceration.
3) Mummification
- Mummification results when death of a fetus occurs from
a deficient supply of blood or when liquor amnii is scanty,
and when no air has entered the uterus.
- The fetus is dried up & shrivelled.

TOPIC 33 : OPIOID POISONING

294. A 34 -year old rickshaw puller has been using heroin

for the past ten years. One evening his family • An opium addict —sores, caused by injecting opium up to
members found him unconscious. He was brought ten times a day
to the casualty. On examination he had tachycardia,
shallow breathing, constricted pupils. His blood
pressure was 100/70 mm of Hg. He had brisk bilateral
deep tendon reflexes. The planter reflexes were flexor
on both sides. Which of the following is the best
treatment for him?
A. Buprenorphine
B. Flumazenil
C. Methadone
D. Naloxone
D
Withdrawl symptoms of opium poisoning:
..........(AIPGMEE - 2004)
Nausea and diarrhea, coughing, lacrimation, mydriasis,
rhinorrhea, profuse sweating, twitching muscles and
The patient is presenting with features suggestive of acute
opioid (heroin) intoxication. ‘The specific antidote for piloerection, or “goose bumps”; mild elevations in body
temperature, respiratory rate and blood pressure In
such acute intoxication is Naloxone’
addition, sensations of diffuse pain, insomnia and yawning,
The opioid antagonist eg naloxone competes with heroin
along with intense drug craving.
and other opioids for receptors, and reduces the effects
of opioid agonist.

296. Which of the following agents causes delirium

Methadone is used in rehabilitation of opioid dependent A. Opium
persons as maintenance therapy. B. LSD
It is not aimed at curing opioid dependence rather C. Cocaine
it provides a substitute drug that is legally D. Dhatura
accessible, safer and can be taken orally. The goal is to ..........(AIPGMEE - 1995)
help person who have repeatedly failed in drug free
programmes. It has no role in Acute opioid intoxication. 297. Opium poisoning Is treated with
• Buprenorphine is a partial opioid agonist. It has no role A. Nalorphine
in acute opioid intoxication Flumazenil is a benzodiazepine B. Atropine
antagonist. C. Neostigmine
D. Physostigmine
295. 60 yrs old man presents in OPD with history of A and D
opium addiction for the last 20 yrs. He has given up ..........(PGI - JUNE 2003)
opium from 2 days. Withdrawal symptoms will include:
A. Drowsiness The specific antidote for opium poisoning is Naloxone.
B. Constricted pupil Nalorphine is used alternatively.

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 TOPIC 34 & 35: OPIUM & CONSENT FORENSIC MEDICINE 5

Naloxone is given 2mg iv in case of respiratory depression 300. Which of the following statements about consent
and repeated every 1/2 - 1 hr. upto a total dose 10 to 20 is ‘not true’:
mg. iv. A. Consent can only be valid if it is given by a person who is
- It can be given im. or sublingually. sane and has attained maturity, ie. age of 18 yrs
- If there is no response with naloxone within two B. For sterilization of a married person, consent of both spouse,
minutes endotracheal intubation is necessary for i.e. husband and wife is required
respiratory depression. C. For artificial insemination, consent of the patient alone is
* In case of respiratory depression physostigmine 0.04 mg./ required
kg. may be given to reverse the respiratory depression. D. In emergency situation, if no near relative is available,
* Artificial respiration should be carried out continuously and doctors can perform procedure/surgery necessary to save
O2 inhilation given in case of deep coma. life even without consent, provided that the procedure
intended is certified to be essential to save life of the
• Atropine is not given in opium poisoning as it may causes patient, by two doctors
death by sensory and motor nerve paralysis. C
If a person present with comatose with unknown poisoning ...........(AIIMS PGMEE NOV - 2002)
following treatment is given :
- 100 ml. 50% glucose. • For artificial insemination the knowledge and full consent
- 100 mg. thiamine. of both spouses are essential. The consent must be in
- 2 mg. naloxone iv. writing.
- Consent of both spouses is essential for any procedure
298. Opium poisoning Is featured by: affecting the rights of a spouse eg. sterilization,
A. Constricted pupil hysterectomy, artificial insemination.
B. Respiratory depression “If the patient is unconscious and delay in obtaining the
C. Tachycardia consent would be dangerous the doctor may examine
D. Tachypnea and treat without consent such a gravely ill person who
E. Hallucination needs immediate treatment or surgery. Care should be
A,B,C,D and E taken that the surgical procedures do not go beyond
..........(PGI - June -2001) the minimum required to save life, and when ever
possible, amputation of limbs, etc is postponed till such
• Opium poisoning characterised by initial stimulation and time proper consent can be obtained”.
then depression of CNS. It has three stages :
— Stage of excitement : Short duration, euphoric maniacal “In India a person of and above 12 years of age can give
feature, hallucinations. consent for medical examination or treatment. *
— Stage of stupor : here pulse, respiration are normal and
tachypnea. A person above 18 years of the age can give valid
— Stage of coma : pinpoint pupil, respiratory depression, consent to suffer any harm, which may result from an act
hypothermia, hypotension and bradycardia. not intended or not known to cause death or grievous
hurt.”
TOPIC 34 : OPIUM “A child under 12 years of the age and an insane person
cannot give valid consent to suffer any harm which
299. All the following are Cardiac poisons except may result from an act done in good faith and for
A. Aconite its benefit.”
B. Opium
C. Oleander 301. A patient of head injury, has no relatives and
D. Nicotine requires urgent cranial decompression; Doctor should
B A. Operate without formal consent
..........(AIPGMEE - 1994) B. Take police consent
C. Wait for relatives to take consent
Opium is not a cardiac poison. D. Take magistrate consent
A
TOPIC 35 : CONSENT ..........(AIPGMEE - 2001)

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 TOPIC 35: CONSENT FORENSIC MEDICINE 6

If the patient is unconscious & delay in obtaining consent

would be dangerous, the doctor may examine & treat
without consent, such a gravely ill person who needs
immediate treatment or surgery.
Even in such cases, care should be taken, that the surgical
procedures do not go beyond the minimum required to
save life.

In the given case, the patient presents with head injury &
denying a cranial decompression at the earliest, could
endanger the patients life. So the doctor should
undoubtedly operate without formal consent, though
however he s hould restrict his sur gery to mere
decompression.
• (4) Any procedure beyond routine physical examination,
such as operation, blood transfusion, collection of blood,
etc. requires express consent.
– It must be taken before the act, but not at the time of
admission into the hospital.

(5) The doctor should explain the object of the examination

• Loco Parentis: In an emergency involving children, when
their parents or guardians are not available, consent is
taken from the person-in-charge of the child, e.g.,
a school teacher can give consent for treating a child
who becomes sick during a picnic away from home town,
or the consent of the headmaster of a residential school.
to the patient, and patient should be informed that the
findings will be included in a medical report.
(6) The doctor should inform the patient that he has right
to refuse to submit to examination and that the result
may go against him. If the patient refuses, he cannot
be examined.
(7) The consent should be free, voluntary, clear, intelligent,
informed, direct, and personal. There should be no undue
influence, fraud, misrep­resentation of facts, compulsion,
threat of physical injury, death or other consequences.

• Any harm caused to a person in good faith, even without

that person’ s consent is not an off ence, if the
circumstances are such that it is impossible for that person
to signify consent, and has no guardian or other person in
lawful charge of him from whom it is possible to obtain
consent in time for the thing to be done in benefit (Sec.
92, I.P.C.). (8) In criminal cases, the victim cannot be examined without
– Nothing is said to be done in good faith which is done his/her consent. The Court also cannot force a person
without due care and attention (S.52, I.P.C.). to get medically examined, against his will.
• (A) In cases of rape, the victim should not be examined
• A person may be involved in an accident, which may without written consent.
necessiate an amputation; if it is done without his • (B) In medico-legal cases of pregnancy, delivery and
consent, it is not an offence. In an emergency, the law abortion, the woman should not be examined without
implies consent. An emergency is defined as a medical her consent.
situation, such as to render immediate treatment advisable
either to save life or to safeguard health.

30 RULES OF CONSENT
• Consent is necessary for every medical examination.
Ordinarily, formal consent to medical examination is not
required, because the patient behaves in a manner which
implies consent.
• (2) Oral consent should be obtained in the presence of
a disinterested third party, e.g., nurse.
• (3) Written consent is not necessary in any case. However,
it should be taken for proving the same in the Court if
necessity arises.

• Written consent should refer to one specific procedure,

and not blanket permission on admission to hospital.
(9) (A) A person is arrested on a charge of committing
Written consent should be in proper form and suitably
an offence, and there may be reasons for believing
drafted for the circumstances. The wording should include
that an examination of his person will provide
a phrase to confirm that the patient has been informed
evidence as to the commission of an offence . A
of the nature of the procedure, before signing and registered medical practitioner can examine such person,
witnessing takes place.
even by using reasonable force, if the examination is

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 TOPIC 35: CONSENT
requested by a police officer not below the rank of
sub-inspector.
• If the accused refuses examination, ‘this may go against
him in criminal proceedings. (B) In the case of a female,
the examination should be made only by or under the
supervision of a female registered medical practitioner
(S.53, Cr.P.C.). Under S.54, Cr.P.C. anarrested person
at his request may be examined by a doctor to
detect. evidence in his favour.
(10) In cases of drunkenness, the person should not be
examined and blood, urine, or breath should not be
collected without his written consent. But, if the person
becomes unconscious or incapable of giving
consent, examination and treatment can be carried
out.
The consent of guardian or of relatives if available, should be
taken. The person can be examined without consent, if
requested by the sub-inspector of police.
• (11) A prisoner can be treated forcibly without consent
in the interest of the society.
• (12) Consent given for committing a crime or an illegal
act, such as criminal abortion is invalid .
• (13) A person above 18 years of age can give valid consent
to suffer any harm, which may result from an act not
intended or not known to cause death or grievous hurt
(Sec.87,I.P.C.).
• A person may be suffering from a disease which is
certain to shorten his life. He can give free and
informed consent to take the risk of operation which
though fatal in the majority of cases is the only
available treatment . The surgeon cannot be held
responsible, if the patient dies.
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FORENSIC MEDICINE 7
(14) A person can give valid consent to suffer any harm which
may result from an act, not intended or not known to
cause death, done in good faith and for its benefit (Sec.
88, I.P.C.).
• If a surgeon operates on a patient in good faith and for
his benefit, even though the operation is a risk, he
cannot be held responsible if the patient dies.
S.87 and 88, I.P.C. are ambiguous and are not specific for
medical treatment. The implication is that consent of
parents or guardians is necessary for surgical or medical
procedures if the patient is a minor
(15) A child under 12 years of age and an insane person
cannot give valid consent to suffer, any harm which may
result from an act done in good faith and for its benefit.
The consent of the parent or guardian should be taken
(Sec.89.I.P.C.). If they refuse, the doctor cannot treat
the patient even to save the life.
• A father giving consent for an operation on the child in
good faith and for the child’s benefit, even though the
operation is risky, cannot be held responsible if the child
dies.
(16) A consent given by a person under fear of injury,
or due to misunderstanding of a fact is not valid .
The consent given by an insane or intoxicated person,
who is unable to understand the nature and consequences
of that to which he gives’ his consent is invalid (Sec. 90,
I.P.C.).
• To represent to a patient that an operation necessary to
save life or to preserve health when that is not the case
or to indicate that it will give greater relief than there is
any reasonable prospect of obtaining is to perpetrate a
fraud on the patient that vitiates his consent.
• (17) Any harm caused to a person in good faith, even
without that person’s consent is not an offence, if the
circumstances are such that it is impossible for that person
to signify consent, and has no guardian or other person in
lawful charge of him from whom it is possible to obtain
consent in time for the thing to be done in benefit (Sec.
92, I.P.C.). Nothing is said to be done in good faith which
is done without due care and attention (S.52, I.P.C.).
 TOPIC 35: CONSENT FORENSIC MEDICINE 8

• A person may be involved in an accident, which may

necessiate an amputation; if it is done without his consent,
it is not an offence. In an emergency, the law implies
consent. An emergency is defined as a medical situation,
such as to render immediate treatment advisable either
to save life or to safeguard health.

• 22) When an operation is made compulsory by law, e.g.,

vaccination, the law provides the consent.

(18) Any communication made in good faith for the benefit

of a person is not an offence, if it causes harm to that
person to whom it is made (S.93, I.P.C.).
A physician in good faith tells & patient that he cannot live.
The patient dies in consequence of the shock. The
physician has not committed any offence. • (23) Consent is not a defence in cases of professional
(19) The doctor should inform reasonably to the patient about negligence.
the nature, consequences and risks of the examination
or operation before taking the consent.

In an obscure case, the doctor should obtain an open consent

to use his discretion. When there are two or more
methods of treatment, the patient should be allowed to
choose and give consent for any method.
If in the course of an operation to which the patient has
consented, the physician discovers conditions that had • (24) For contraceptive sterilisation, consent of both the
not been anticipated before the operation began, and husband and wife should be obtained.
which would endanger the life or health of the patient if
not corrected, the doctor would be justified in extending
the operation to correct them, even though no express
consent was obtained.

(20) Consent of the inmates of the hostel, etc., is necessary

if they are above 12 years.
• Within 12 years, the principal or warden can give consent.
If an inmate above 12 years refuses treatment, and he is
likely to spread the disease, he can be asked to leave
the hostel. However, if he stays in hostel. he can be
treated without his consent.
• (21) The nature of illness of a patient should not be
disclosed to any third party without the consent of the
patient.
• (25) The consent of one spouse is not necessary for an
operation or treatment of other.
– A husband has no right to refuse consent to any
operation, including a gynaecological operation, which
is required to safeguard the health of his wife. The consent
of wife is enough. It is advisable to take the consent of
the spouse whenever practicable, especially if the
operation involves danger to life, may destroy or limit sex
functions, or may result in the death of an unborn child.
(26) It is unlawful to detain an adult patient in hospital against
his will.
If a patient demands discharge against medical advice,
this should be recorded and his signature obtained.
• (27) A living adult person can give consent for donating
one of his kidneys to be grafted into another person.
The donor must be informed of the procedure involved

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 TOPIC 35: CONSENT
and possible risks. The donation should not be accepted,
if there is any risk of life of donor.
• (28) If any person has donated his eyes to be used
for therapeutic purpose after his death , the eyes
can be removed only with the consent of guardian or
legal heirs.
• (29) If any person has donated his body to be used for
therapeutic or research purposes after his death, it is not
binding on his spouse or next of kin.
• For organ transplantation, the organs of the dead person,
such as heart, kidney, liver, etc. should not be removed
without the consent of the guardian or legal heirs .
Precautions should be taken to preserve the anonymity
of both donor and recipient.
• (30) Pathological autopsy should not be conducted
without the consent of the guardian or legal heirs of the
deceased. If the autopsy is done without consent, the
doctor is liable for damages for the mental anguish suffered
by heirs due to the mutilation of the body.
• Specific authorisation should be obtained for retention of
organs and parts of the body.
• In medico-legal autopsies (statutory authorisation),
consent is not required and the doctor can remove from
the cadaver anything that is essential for purposes of
examination
302. Not true about consent is
A. Explaining to the patient the nature of his disease, the
proposed tre atment or procedure, th e lternative
procedure, the risks and benefits involved in bom the
proposed and alternative procedure, the relative chances
of success or failure of both procedures
B. In cases of emergency consent is not necessary.
C. In criminal cases, the victim cannot be examined without
his/her consent.
D. Blanket consent authorizers the attending physician or
surgeon to do what ever he thinks best for him under
the circumstances
D the risks or possible consequences of refusal.
...........(AIIMS PGMEE - NOV 2007)
Blanket consent form utilized by most hospitals and surgeons
(in which the patient authorizes the physician or the
surgeon to do whatever he thinks best for him under the
circumstances) is not of value in court. Consent is to be
obtained for each specific procedure or operation.
Consent
• The term consent means voluntary agreement, compliance
or permission. It may be implied or expressed
• Implied consent is a consent which is not written but is
provided by the behaviour of the patient. (When a pt.
Visits or calls on the doctor with his complaints, his consent
for necessary medical examination is implied.) It is the most
common type of consent and is legally valid.
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FORENSIC MEDICINE 9
It implies consent to medical examination in a general sense
but not to procedures more complex than inspection,
palpation, percussion and auscultation.
• Expressed consent - is one the terms of which are stated
in distinct and explicit language. It may be oral or written.
For majority of relatively minor examinations or therapeutic
procedures, oral consent is used. It should be obtained in
the presence of a disinterested third party (e.g. nurse).
Oral consent when properly witnessed, is as valid as
written consent, but written consent has the advantage
of easy proof and permanent form.
• Informed consent - To be legally valid the consent that is
given must be informed, that is the consent must be
given after understanding what it is given for and the risk
involved.
The doctor must therefore give full information to the patient
regarding the diagnosis, nature of treatment or procedure,
alternative procedures, risks involved, prospects of success,
prognosis if the procedure is not performed.
• Informed refusal - Before refusing a particular procedure
or treatment, the pt. must be fully informed by the doctor
• Therapeutic privilege (or thereapeutic exceptions) -
Some apprehensive or neurotic patients may be harmed
by giving them the full information. They may refuse the
necessary treatment inspite of little risk or suffer
psychological trauma from such disclosure . In such
cases the doctor may use discretion as to the facts which
he discloses. The doctor may obtain informed consent
from a responsible relative, or in his absence obtain
medical consultation and note down his decision in
patient’s record, explaining his intention and reasons of
the therapeutic privilage.
• The presence of a malignancy or an unavoidable fatal lesion
may not be disclosed, if the doctor feels the pt. is not
able to tolerate the news. If possible it should be explained
to patients spouse or next of kin
 TOPIC 36: GASTRIC LAVAGE FORENSIC MEDICINE 10

303. A boy attempts suicide. He is brought to a private

Whenever poisoning has occurred in the preceding eight
doctor and he is successfully cured. Doctor should:
hours or so, a gastric lavage must be done (except
A. Inform police
when contraindicated), irrespective of whether vomiting has
B. Not required
occurred or not, to prevent aspiration of contents.
C. Report to magistrate
It is contraindicated in:
D. Refer to a psychiatrist
1. Corrosive poisonings except carbolic acid.
A
2. Kerosene or volatile poisoning.
..........(AIPGMEE - 2001)

Here the question is one of privelieged communication on

the one hand & responsibility of the doctor towards the 305. Gastric lavage is contraindicated in poisoning with
state/as a citizen on the other hand. A. Sulphuric acid
Police needs to be informed when: B. Organophosphorus compounds
- crime is of a servere nature as for e.g. murder, also C. Arsenic
- crime is of a sufficiently severe nature and informing the D. Dhatura
police is likely to assist in its detection. A
Such cases are grouped as duties of the doctor as a ..........(AIPGMEE - 1995)
citizen and include informing in cases such as of Rape or
a serious assault Treatment of Mineral acid Poisoning :
• Gastric lavage is contraindicated in poisoning due
However, when- the harm involved is of a lesser degree, or, to mineral acids (eg. Sulphuric acid, Nitric acid,
- his patient alone is involved as both the doer and the victim Hydrochloric acid). It is not contraindicated in
eg in attempted sucide or self induced abortion, organic acids.
Then, The doctor is naturally less inclined as a citizen &not • However, a soft stomach tube or Levine tube (not lavage)
bound legally to reveal such information. can be passed wi th care for the p urpose of
Even in such conditions however, if the patients condition preventing serious strictures.
is serious, or if he is likely to die the doctor must arrange
to record his dying declaration or dying deposition by
informing the nearest magistrate.
If the condition is not serious, as in this case where the
patient is successfully cured & there is no danger to life,
he need not inform the police or anybody.

TOPIC 36 : GASTRIC LAVAGE

304. Gastric lavage is indicated in all cases of acute

poisoning ideally because of:
A. Fear of aspiration
B. Danger of cardiac arrest
C. Danger of respiratory arrest
D. Inadequat ventilation
A
..........(AIPGMEE - 2002)

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 TOPIC 37: INQUEST FORENSIC MEDICINE 11

• If acid has been taken, alkaline ca rbonates are TOPIC 37 : INQUEST

contraindicated, but weak alkalis (eg. milk of magnesia) &
plenty of water or neutralizing agents such as milk and 308. A lady died due to unnatural death within seven
egg albumin should be given. years after her marriage. The inquest in this case will
• If alkali has been taken, weak acid such as vinegar can be be done by
given. A. Forensic medicine expert
• Steroids are indicated for shock & for preventing strictures. B. Deputy Superintendent of Police
• Symptomatic treatment is continued. C. Sub-divisional Magistrate
Morphine for pain D. Coroner
Ice to suck for thirst iv fluids. C
..........(AIIMS PGMEE - MAY 2004)
306. Gastric lavage can be done in poisoning by:
A. Carbolic acid 309. In India, magistrate inquest is done in the following
B. Oxalic acid cases except:
C. Sulphuric acid A. Exhumation cases.
D. Caustic potash and soda B. Dowry deaths within 5 years of marriage.
A,B and D C. Murder cases
..........(AIPGMEE - 1997) D. Death of a person in police custody
C
Carbolic acid, Oxalic acid, Caustic potash and soda ..........(AIPGMEE - 2005)
The following general principles apply in treating cases of
Acute Poisoning. Inquest in cases of murder is a ‘police inquest’. This
1. Removal of unabsorbed poison. means inquiry by a police officer, into the causes of
2. Use of antidotes unnatural or suspicious death.
3. Elimination of poison
4. Symptomatic management

If the patient has swallowed the poison, gastric lavage is

indicated to remove, dilute, neutralise the unabsorbed
poison in the stomach.
Gastric lavage is Contra-indicated in poisoning due to
Inorganic (Mineral) Acids.
e.g. H2SO 4, HNO 3, HCI, HF.
It, however, can be done in all cases of Organic Acid
poisoning.
e.g. Aspirin, Oxalic acid, Carbolic acid, Picric Acid, Acetic
Magistrate’s inquest:
acid, Tartaric acid, Citric acid.
This means an enquiry conducted by a magistrate to ascertain
It can also be done in cases of ‘mild’ alkali poisoning
matters of fact.
(even in mineral alkalies like KOH, NaOH).
It is held in the following cases:
But are contra-indicated in severe alkali poisoning.
• Death of a convict in jail
• Death of a person in police custody or during police
• This can be done with caution & after first neutralising
interrogation
the acid for example with Acetic acid or Tartaric acid
• Death as a result of police shooting / hilling
• Exhumation cases
307. Gastric lavage is contraindicated in poisoning with • Dowry death (Sec 176 Cr Pc)
A. Morphine • Death in a psychiatric hospital
B. Kerosene
C. Carbolic acid
D. Diazepam
B
..........(AIIMS PGMEE - MAY - 1993)

Gastric lavage is contraindicated in kerosene poisoning

because it will lead to Aspiration.
Contraindications of Gastric lavage
Absolute -
Corrosive poisoning (except carbolic acid)
Relative -
• Kerosene and other volatile poisoning (If done, airway
310. Corpus delicti means
should be sealed by cuffed intubation)
A. Essence of crime
• Strychnine (If done, convulsions should be controlled)
B. Inquest into death
• Comatose patient
C. Postmortem examination
• Hypothermia (If done, body temperature would need
D. Death by asphyxia
careful attention) Esophageal varices A
• Hemorrhagic diathesis ..........(AIIMS PGMEE - MAY 2008)

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 TOPIC 38: MTP FORENSIC MEDICINE 12

• The Corpus delicti means the body of offence or the 313. ‘Vagitus uterinus’ is -
essence of crime, i.e. the facts of any criminal offence A. An infection of vagina
e.g. murder B. An infection of uterus
• It includes C. A cry of unborn baby from uterus
1. Positive identification of body and D. Infection of both vagina and uterus
2. Other facts which are conclusive of death by foul play C
such as a bullet or a broken knife, blade found in the ..........(AIIMS PGMEE - NOV 2005)
body and responsible for death.
Vagitus - First cry of newly born infant
TOPIC 38 : MTP Vagitus uterinus - Crying of the fetus before birth while
still in the uterus or you can say that the child started
311. Which o f the following best d escribes the breathing while it is in womb (after rupture of membranes).
mechanism of induction of labor with use of abortion
stick:
A. Stimulation of uterine contraction
B. Oxytocin present in the stick
C. Uterine necrosis
D. Menstrual bleeding
A
…….(AIPGMEE - 2008)

An abortion stick is a method of criminal abortion

commonly used by professional abortionists (dhais) in India.
It involves introduction of a thin wood or bamboo stick
into the vagina or ‘os’ offhf uterus to irritate the uterus
and initiate uterine contractions.
Abortion stick (Method used by Midwife /Abortionist
in India) • Vagitus vaginalis - Cry of an infant with head still in the
• Abortion Stick is a thin wooden or bamboo Stick about vagina or you can say that the child has started breathing
15 to 20 cm long while its head is in the vagina
• The wooden /bamboo stick may be wrapped with cotton,
wool/cloth and seaked with juite of an irritant plant

Irritants include
Juice made up of marking nut, calatropis, jequirity, or
asafatida paste made up of arsenous oxide, arsenic
sulphate, mercuric chloride or red lead
The abortion stick is introduced into the vagina or os of
the uterus and retained there till uterine contractions begin

312. Which are true about MTP?

A. Pregnancy caused by rape What is the significance of vagitus uterinus?
B. If mother is not agreeing for termination but husband is - This is used to find out whether the dead child was born
willing live or not.
C. If maternal health is in danger - It is believed that breathing is a proof of live birth.
D. Between 12 to 20 weeks one doctor is necessary for - But these two cases have proved that a child can breathe
termination in the vagina or uterus and a child who has breathed in
E. Proof of age is not required the womb or vagina may die from natural causes before it
A,C and E is completely born.
..........(PGI - DEC 2005) - Therefore proof of breathing is not a proof of
livebirth.
* Under MTP act pregnancy can be terminated in the
following conditions : 314. Abortion stick used in criminal abortion causes
1. Therapeutic: when continuation of pregnancy endangers abortion by the mechanism of
life of the woman and may cause serious injury to her A. Uterine contraction
physical and mental health. B. Stimulation of uterine nerves
2. Eugenic: When there is risk of child being born with serious C. Uterine infection & necrosis
physical or mental abnormality. D. Placental separation
3. Humanitarian: When pregnancy has been caused by rape. A
4. Social. ..........(AIIMS PGMEE - NOV 2006)
* Consent of the women is only required, the consent of
the husband is not necessary. • Irritant plants twig used for abortion
* Women need not produce the proof of her age. - madar (Calotropis)
* If period of pregnancy is between 12-20 weeks opinion - chitra (Plumbago zeylanica)
of two doctors is necessary. - lal chitra (Plumbago rosea)
- kaner (Nerium odorum)

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 MINOR TOPICS FORENSIC MEDICINE 13

TOPIC 39 : PUGILISTIC ATTITUDE • Suspended animation or apparent death is a condition

315. Pugilistic attitude is due to:
A. Coagulation of proteins of muscle
B. Loss of sodium from muscles
C. Loss of water from muscles
D. Loss of potassium from muscles
A •
..........(AIPGMEE - 2000), AIPGMEE – 1996
AIPGMEE – 1998, PGI - June -1999
In the case of burns, the body presents a peculiar attitude,
the so called attitude of defence, also known as ‘Pugillistic
Attitude or ‘Boxing Attitude” or ‘Fencingposture
This condition is due to coagulation of proteins2, other than
those affected by rigor mortis2.
where signs of life are not found, as functions are
interrupted for sometime or are reduced to minimum.
However life continues & resuscitation is successful in such
cases. The metabolic r ate is so reduced that the
requirement of individual cell for oxygen is satisfied through
the use of oxygen dissolved in the body fluids.
It may be produced voluntarily. Practitioners of yoga can
pass into a trance, death like character. Involuntary
suspension of animation lasting from a few seconds to
half-an-hour or more may be found in new born infants,
drowning, electrocution, cholera, after anaesthesia, shock,
sunstroke, Cerebral Concussion, insanity etc.
The patient can be resuscitated by cardiac massage or electric
stimulator & artificial respiration.

322. The phenomenon of suspended animation may be

seen in
A. Throttling
B. Drowning
C. Strangulation
D. Brain hemorrhage
B
..........(AIIMS PGMEE - MAY 2004)

• Suspended animation –
It is called so since the flexors contract more than the • It is a condition in which the vital functions of the body
extensors giving the body an attitude of generated flexion (heart beat and respiration) are at such a low pitch that
or ‘boxing attitude’. they cannot be detected by routine methoods of clinical
Note however; this condition holds no medicological examination. This state is also known as apparent death.
significance , because this attitude of the body is present
whether a living body is burnt or dead body is • Causes of suspended animation
burnt. Q 1. Drowning
2. Electrocution
TOPIC 40 : suspended animation 3. Heatstroke
4. After anaesthesia
319. Suspended animation may be seen with: 5. Cerebral concussion
A. Electrocution 6. Typoid fever
B. Strangulation / hanging 7. Deep shock
C. Drowning 8. Overdose by barbiturates or opiates
D. Burn 9. Mesmeric trauma
A 10.In the new born
..........(AIPGMEE - 1999) 11.Yogi’s can voluntarily bring about this state.

SUSPENDED ANIMATION is a condition in which the vital TOPIC 41 : aluminium phosphide

functions of the body are at such a low pitch that they
can not be detected by Routine methods of clinical 323. Gastric lavage turns black in presence of Silver
examination. nitrate, most probable poisoning was
This state is called ‘APPARENTDEATH A. Celphos
This state may be seen in: B. Malathion
1. apparently drowned Q 5. heat-stroke Q C. Organophosphorus
2. after anaesthesia Q 6. overdose of barbiturates D. Parathion
or opiates Q A
3. in cerebral concussion Q 7. prolonged illness of ..........(PGI - JUNE 2004)
typhoid
4. electrocution Q 8. deep shock Q 324. In aluminium phosphide poisoning not true is:
A. Accumulation of acetylcholine at NM junction
320. Suspended animation is B. Cytochrome oxidase inhibition
A. Apparent death from which person can be aroused C. Phosphine formation
B. Subject is alive but shows no signs of life D. Metabolic acidosis
C. Animal suspended A
D. Hibernation ..........(PGI - June -1998)
A and B
..........(PGI - 1997 - Dec) Aluminium phosphide liberates phosphine in contact with
..........(PGI - June -1998 moisture. Phosphine is a systemic poison.

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 MINOR TOPICS FORENSIC MEDICINE 14

• It acts by in inhibiting electron transport chain preferably

cytochrome oxidase.

325. On stomach washing which poison turns to black

on exposure to silver nitrate-
A. Tik 20
B. Celphos
C. Malathion
D. Arsenic
B
..........(AIIMS PGMEE NOV - 2001) Marihuana or Marijuana is a mexican term meaning ‘pleasurable
feeling’ and is used in America to refer to Cannabis.
Aluminium phosphide is used as rodenticide

327. “Run-amok” is found in

• Celphos or Aluminium phosphide liberate phosphine gas
on coming in contact with moisture. Phosphine reacts
with silver nitrate and gives black colour.
TOPIC 42 : CANABIS
326. Charas is
A. Leaves of Cannahis Indica
B. Flowers of Canmibis Indica
C. Stem of Cannahis Indica
D. Resin exudate of Cannabis Indica
D causes degeneration of the central nervous system and
..........(AIPGMEE - 1995)
Charas is produced from the resinous exudate from
the leaves and stems of the plant.
Cannabis sativa or Cannabis indica is the source of some of
the most commonly abused drugs. The active principle is
a fat soluble olioresin, cannabinol.
A. Cocaine
B. Cannabis
C. Barbiturates
D. Dhatura
B
....(AIIMS PGMEE - SEP 1996), AIIMS PGMEE - JUNE 1998
CANNABIS SATIVA OR INDICA
it is also known as Indian hemp, hashish or marihuana
Chronic Poisoning : The use of the drug in small quantities
even for long period is not harmful. Used in excess, it
insanity. Chronic use reduces serum testosterone and
sperm count.
There is loss of appetite, weakness, wasting, tremors, sleepy
facial expression, vacant look, red eyes, impotence and
moral and mental deterioration. Rarely they become insane
(hashish insanity), and may suffer from hallucinations and
delusions of persecution.
The person may run amok, i.e., he develops a psychotic
disturbance marked by a period of depression,
followed by violent attempts to kill people (impulse
to murder).

Bhang Dried leaves and fruit shoots

Ganja Dried flowering tops of female
plant
Charas (Hashish) Resinous exudate from leaves
and stem of the plant

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 MINOR TOPICS FORENSIC MEDICINE 15

He first kills a person against whom he may have real or

imaginary enemity and then kills anyone that comes
in his way until the homicidal tendency lasts .
Then he may commit suicide or may surrender himself. If
the abuse is continued for a considerable time, it may
lead to behavioural problems, crime and even mental
derangement.
It does not cause physiological dependence or
addiction

TOPIC 43 : carbonmonoxide poisoning

329. Postmortem finding in carbon monoxide poisoning

is:
A. Cherry red blood • First permanent teeth or appear is —. First molar
B. Intense cyanosis
C. Excessive salivation
D. Pin point pupil
A
..........(PGI - JUNE 1997), PGI - June -2001

A cherry red Colouration of the skin, mucous membranes,

areas of hypostasis, blood, tissues & internal organs is the
outstanding feature of carbon monoxide poisoning.

331. Diffusion of oxygen at the tissue level is affected

in all the following poisonings except:
A. Carbon monoxide
B. Curare
C. Phosgene
D. Cyanides TIMING OF ERRUPTION OF TEETH*
B • Primary:
..........(AIIMS PGMEE - MAY 2005) Lower central incisors −−> 5-8 months
Upper central Incisors --> appear a month later
• Curare Lateral Incisors --> appear 2-3 months later
Its mechanism of action, as well known, is to block the 1st molar --> 12-15 months
postsynaptic acetylcholine receptors in muscles thus Canines --> 18-21 months
causing flaccid paralysis of skeletal muscles. 2nd molar --> 21 – 24 months
• All the other options are asphyxiants ie poisonous gases
which produce respiratory embarrassment. However, their • Secondary:
mechanism of actions are qute different: 1st molar --> 6 years
Incisors --> 6-8 years
a) Phosgene. Canines and premolars --> 9- 12 years
It causes irritation and desquamation of respiratory tract (Premolars earlier
epithelium. Patient dies of acute pulmonary oedema or than canines)
bronchopneumonia. IInd molar --> 12 years
IIIrd molar --> 18 years or later
b) Carbon monoxide
It combines with hemoglobin to form a relatively stable 333. A boy has 20 permanent teeth and 8 temporary
compound carboxyhemoglobin, and thus hamper the teeth. His age is likely to be:
transport of oxygen by hemoglobin. A. 9 yrs.
c) Cyanide B. 10 yrs.
It inhibits the steps ofoxidative phosphorylation, thus hampers C. 11 yrs.
the utilization of 02 by the tissues. D. 12 yrs
C
TOPIC 44 : dentition ...........(AIPGMEE - 2001)
332. The first permanent tooth to appear is
A. First molar
B. Lateral incisor
C. Upper canine
D. First premolar
A
..........(AIIMS PGMEE - JUNE - 1997)

• First primary teeth or appears is àLower central incisor*

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 MINOR TOPICS FORENSIC MEDICINE 16

TOPIC 45 : HANGING
Permanent teeth Eruption time
First molar 6-7 years 335. When a person has suspended himself by applying
ligature around neck so that the point of suspension
Central incisor 6-8 years (knot) is situated in the region of the occiput. Such
Lateral incisor 8-9 years a hanging is called as -
First bicuspid 9-11 years A. Typical
B. Atypical
Second bicuspid 10-12 years
C. Partial
Canines 11-12 years D. Incomplete
Second molars 12-14 years A
Third molars 17-25 years ..........(AIIMS PGMEE - NOV 2004)

20 Permanent teeth would correspond to appearance

of teeth up to the second Bicuspid. This would
correspond to an age of 10-12 years.
The answer of choice here thus should be 11 years. 336. ‘La facies sympathique’ is a condition seen in cases
Permanent teeth Eruption time of -
First molar 6-7 years A. Hanging
Central incisor 6-8 years B. Strangulation
Lateral incisor 8-9 years C. Myocardial insufficiency
First bicuspid 9-11 years D. Railway accidents
Second bicuspid 10-12 years A
Canines 11-12 years ..........(AIIMS PGMEE - NOV 2005)
Second molars 12-14 years
Third molars 17-25 years • La facies svmpathique occurs in hanging
• On postmortem examination, in hanging, usually the eyes
Permanent teeth Eruption time are closed or partly open and the pupils are usually dilated.
Sometimes, when the ligature knot presses on the
cervical sympathetic, the eye on the same side may
remain open and its pupil dilated (La. facies
svmpathique). This indicates antemortem hanging.

337. The “knot” in judicial hanging is placed at

A. The back of the neck
B. The side of the neck
C. Below the chin
D. Choice of hangman
B
..........(AIIMS PGMEE - NOV 2006)
• Though submental knot (below the chin) is thought
to be more effective and ensures a quicker death ;
334. Which of the following is true about eruption of subaural knot (side of the neck under the angle of the
teeth? jaw) on the left side is the preferred position in India as
A. Premolar appear in primary dentition well as England.
B. Incisors appear first to appear in secondary dentition
C. 3rd molar is the last to develop
D. Hypothyroidism delays dentition
E. Canines is last to appear in primary dentition
B,C and D
..........(PGI - DEC 2005)

* Hypothyroidism delays the dentition and in case of syphillis

there is early dentition.
* Premolar is not seen in Primary dentition.
* Second molar is last to appear in Primay dentition
* 3rd molar is last to appear in secondary dentition.

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• Judicial hanging causes fracture-dislocation usually at the 339. A dead body is found to have marks like branching
level of 2nd and 3rd or 3rd and 4th cervical vertebrae. of a tree on front of chest. The most likely cause of
B/l fractures of either the pedicles or laminae of the arch death could be due to -
of the 2nd, 3rd or 4th cervical vertebrae occur. A. Fire-arm
• In proper judicial hanging, there is rupture of the brain B. Lightening injury
stem between thepons and the medulla. C. Injuries due to bomb blast
D. Road traffic accident
B
..........(AIIMS PGMEE - NOV 2005)

• In injury due to lightening the arborescent marks are

formed due to passage of electric current in the body.
• These marks are so called because their appearance is
like that of branching tree.
• These are formed due to rupture of the smaller blood
vessels at several places giving rise to ecchymoses with
an arborescent pattern.
• This results in instantaneous and irreversible loss of • These markings fade with time.
consciousness (d/t destruction of reticular formation) and
in irreversible apnoea (d/t destruction of the respiratory 340. Filigree burn occur in
centre). A. Lightening
• Death is instantaneous due to damage to spinal cord or B. Electrocution
brain stem though the heart may continue to beat for C. Vitrilage
15 to 20 minutes and muscle jerking may occur for quite D. Infanticide
some time. A
..........(AIIMS PGMEE - DEC 1998)
TOPIC 46 : lightening injury

338. Arborescent marks seen in :

A. Head injury
B. Thermal burns
C. Lightening injury
D. Electric burns
C
..........(AIIMS PGMEE - MAY 1995)

• When the effect of lightening (electrocution) is very

superficial then there are only surface burns involving only
the epidermis. There is erythema of the skin with the TOPIC 47 : ossification centre
pattern like the branches of a tree and therefore
known as arborescent markings or filigree burns. 341. The fetus can be considered viable if the following
– Joule burns* are seen in electrical burns ossification center appears :
– Crocodile skin effect* is seen in electrical burns (d/t very A. Calcaneum
high voltage) B. Manubrium sterni
There is erythema of the skin with the pattern like the C. Lower end of femur
branches of a tree and therefore known as arborescent D. None of the above
markings or filigree burns. C
..........(PGI - June -1999)

Viability means the stage of maturity at which a foetus with

– Crocodile skin effect is seen in electrical burns (d/t very
high voltage)
normal intrauterine development is able to maintain a
seperate existance after birth.
— A child is viable after 210 days or seven months of
intrauterine life and in some cases after 180 days or 6
months.
• At the end of seven months the primary centre of Talus
appear.
• At the end of nine month ossification centre of lower
end of femur appears
— Mannubrium sterni centre appears at 5th month.
The centre of calcaneum appears at the end of 5th month.

342. Best bone to assess age between 20-50 yrs. :

A. Skull
B. Ribs
C. Sternum

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 MINOR TOPICS FORENSIC MEDICINE 18

D. Symphysis pubis B. Carbon dioxide

A C. Aniline dye
..........(PGI - June -2000) D. Phosphorus
D
• Absence of any sign of closure of any of the suture of the ..........(AIIMS PGMEE - NOV 2004)
skull points to a strong posibility that the age dosn’t
exceed thirty yr. 346. A person presents to the emergency with rigors
• The suture between the basiocciput and basisphenoid is and chills and a clinical picture resembling malaria,
completed at 18-22 yrs. which of the following poisoning is likely -
• Closure start of Saggital sutures at 30-35 yrs A. Mercury
B. Red phosphorous
Coronoid 35-40 yrs. C. Zinc
Lambdoid suture 45-50 yrs. D. Arsenic
C
343. For age determination of 21 year old female, site ..........(AIIMS PGMEE - NOV 2006)
for X- ray done
A. Elbow and shoulder • The patient is having Metal fume fever
B. Wrist • Metal Fume Fever
C. Hip and knee - Is caused primarily by exposure to Zinc oxide fume (ZnO)
D. Iliac crest and clavicle in the workplace. The main cause of this exposure is
D usually breathing the fumes from welding or heating
..........(AIIMS PGMEE - DEC 1997) galvanized metal.
- Symptoms are flu-like including headache, fever, chills,
• By 18-20 years of age the epiphysis at the iliac crest and muscle aches , thirst, nausea, vomiti ng, fatigue,
lateral end of the clavicle should be united. gastrointestinal pain.
- The symptoms usually start several hours after exposure
and last for 6 to 24 hrs.
- Sweating and chills may occur before the temperature
return to normal.

- Complete recovery generally occurs without intervention

within 24 to 48 hrs. Only symptomatic treatment may be
needed (aspirin for fever).
- Other elements, such as copper, magnesium, nickel,
mercury etc. may cause metal fume fever, but zinc is the
most common cause.
• By 22 years, the inner epiphyses of clavicle fuses.
• So by X-ray of clavicle and iliac rest we can confirm her TOPIC 49 : POND FRACTURE
age to be 21 years.
347. Pond’s fracture is most common in:
A. Children
B. Elderly
C. Adolescent
D. Middle aged women
A
...(AIPGMEE - 2000), AIPGMEE – 1996, AIPGMEE - 1998

Pond’s fracture or Indented fracture occur in children

due to elasticity of their skull bones. :

TOPIC 48 : phosphorus poisoning • Signature fracture is same as Depressed fracture : and

is caused by a heavy weapon with a small striking surface,
344. Yellow Fatty liver is characteristic of poisoning with e.g. hammer.
A. Arsenic
B. Mercury • Gutter fracture : When a part of the thickness of the
C. Phosphorus skull bone is removed e.g. in glancing bullet wounds.
D. Oxalic Acid
C • Ring fracture: describes any fracture around foramen
..........(AIPGMEE - 2008) magnum. It occurs most commonly from direct violence
e.g. fall from a height on the feet or buttock.
345. A body is brought for autopsy with history of
poisoning. On postmortem examination, there is dark • CSF Rhinorrhea and Black eve: are features of fracture
brown postmortem staining and garlic odour in of Anterior Cranial Fossa.
stomach. In this case the poisoning is most likely
due to - • CSF otorrhea : Is a feature of fracture of Middle Cranial
A. Hydrocyanic acid Fossa.

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 MINOR TOPICS FORENSIC MEDICINE 19

Criminal responsibility and relevant sections under IPC:

Under Section A child under the age of seven is

82 IPC incapable of committing an offence. This
is so because action alone does not amount
to guilt unless it is accompanied by a guilty
mind. And, a child of that tender age cannot
have a guilty mind or criminal intention with
which the act is done. This presumption,
however, is only confined to offenses under
TOPIC 50 : semen tests the IPC but not to other Acts, e.g., the
Railway Act.
350. Florence test is used for Under Section A child above seven and under twelve years
A. Blood 83 IPC of age is presumed to be capable of
B. Semen committing an offenceit he has obtained
C. Urine sufficient maturity to understand and judge
D. Albumin the nature and consequences of his conduct
B on that occasion. The law presumes such
..........(AIIMS PGMEE - SEP 1996) maturity in a child of that age unless the
contrary is proved by the defence.
Chemical tests used to detect semen in stains
• Florence test:
Depends on the presence of choline* in semen Under Section A child under 12 years of age cannot give
• Acid phosphatase test: 89 IPC valid consent to suffer any harm which can
Depends on the presence of acid phosphatase* in semen occur from an act done in good faith and for
• Barberio’s test: its benefit, e.g., a consent for an operation.
Depends on the presence of spermin* in semen Only, a guardian can give such consent.
Under Section A person under 18 years of age cannot give
351. Spermin is detected in semen by which test- 87 IPC valid consent, whether express or implied , to
A. Barberio test suffer any harm which may result from an
B. Florence act no intended or not known to cause death
C. ELISA or grievous hurt, e.g. consent for a wrestling
D. Agglutination inhibition contest.
A
..........(AIIMS PGMEE - Dec - 1995) TOPIC 52 : AUTOPSY

352. Which of following tests in used to detect semen? 355. Certain obligations on the part of doctor who under
A. Phenolphthalein test takes postmortem examination are following except:
B. Reine’s test A. The examination should be meticulus and complete
C. Barberio’s test B. Routinely record all positive findings and important negative
D. Paraffin test ones
C C. He must keep the police informed about the findings
..........(AIPGMEE - 2006) D. He must preserve viscera and send for toxi-cology
examination in case of poisoning
TOPIC 51 : age medicolegal importance C
..........(AIIMS PGMEE NOV - 2002)
353. Age limit for marriage in Men :
A. 15 Its not obligatory on the part of doctor to keep the police
B. 16 informed about the findings.
C. 18 Its only after that the autopsy is completed and the
D. 21 doctor has formed an opinion about the cause and mode
E. 25 of death, he prepares a detailed postmortem report.
D This report is send to the investigating police officer.
..........(PGI - JUNE 2006) Before the detailed report is prepared the doctor may
send a summary of his opinion to the police officer but its
354. The minimum age at which an individual is not obligatory for him to keep the officer informed about
responsible for his criminal act is: the finding.
A. 7 years.
B. 12 years. Rules for postmortem examination
C. 16 years. 1) A post-mortem examination is never under taken unless
D. 21 years there is a written order from a police officer, the district
A magistrate or the Corner (Mumbai).
...........(AIPGMEE - 2005)
2) The examination has to be meticulous and complete.
Any act which is done by a child under seven years of Partial postmartem is not permitted.
age is not an offence (See 82, IPC). 3) The doctor should routinely record all the positive findings
and important negative ones.

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 MINOR TOPICS FORENSIC MEDICINE 20

4) All the information must be preserved by written records, fractures of skull. Carboxy hemoglobin was 25% and
sketches, relevant photographs and radiographs when soot particles were present in trachea.
possible. Which of the combinations of two findings will establish
5) The doctor must preserve viscera and send for toxicology that the burns were antemortem in nature
examination in case of poisoning. A. Heat haematoma & heat ruptures
6) As far as possible, the examination should be conducted B. Heat fracture of skull and peeling of skin
in daylight, and not in artificial light. C. Heat haematoma and pugilistic attitude
D. Carboxy hemoglobin (25%) and soot particles in trachea
7 After the autopsy is completed, and an opinion formed as D
to the cause and mode of death, the doctor prepares a ..........(AIIMS PGMEE - MAY 2004)
detailed postmartem report in triplicate.
One copy is send to the investigating police officer, another Difference b/w Antemortem and Postmortem burn.
to the Super­intendent of police/Magistrate, and the third
retained as office copy. Antemortem burn Postmortem
burn
Line of redness Present Absent
356. Which is true about Somatic death :
Vesicles Contain albuminous Contain air
A. Cooling of the body.
fluid and chloride.
B. Cessation of spontaneous respiration
Infection Pus and sloughing NIL.
C. Cessation of circulation
D. Flat isoelectric E. E.G Healing Granulation NIL
E.. Deep unconsciousness with no response to external stimuli Soot hi upper respiratory tract Present Absent
or internal need Carboxy hemoglobin hi blood Present Absent
B,C,D and E Enzymes Increased No change
..........(PGI - DEC 2003)
• Note : Features such as heat, hematoma, heat
Somatic death or clinical death is the complete and rupture, peeling of skin can o ccur in both
irreversible cessation of the vital functions of brain, antemortem and post mortem wounds.
heart and lungs.
* In somatic death though life ceases, cells responds to TOPIC 54 : counter coup injuries
chemical, thermal and electrical stimuli. The signs of
somatic death or immediate signs of death are : 359. Contre-coup injuries are seen in :
* Insensibility to touch, pain, temperature and loss of voluntary A. Brain
power. B. Diazepam
* Cessation of circulation C. Flumazenil
* Loss of E.C.G. rhythm. D. Ethyl alcohol
* Loss of E.E.G rhythm. A
* Cessation of respiration ..........(AIPGMEE - 2004)
* Cooling of body is the sign of cellular death.
360. Contre-coup injury is a feature of injury to:
TOPIC 53 : burns A. Brain
B. Stomach
357. Pugilistic attitude is most common in woman dying C. Spleen
with: D. Heart
A. Antemortem burns A
B. Post mortem burns ..........(AIPGMEE - 1999)
C. Asphyxia
D. Carbon monoxide poisoning Contercoup or Coup injury : is generally seen in the region of
A and B the head.
..........(PGI - JUNE 1997) A coup injury is one which occurs immidiately subjacent to
the area of impact.
• In burns the body presents a peculiar attitude, the so
called attitude of defence, known as boxing attitude,
pugilistic attitude or fencing attitude. It is due to
heat stiffening. Since the flexors contract more than the
extensors, the body presents an attitude of generalized
flexion. This attitude of the body is present whether a
living body is burnt or a died body is burnt & has therefore
no medicolegal significance.
The condition is due to coagulation of proteins other
than those affected by rigor mortis. It differs from rigor
mortis that, it is permanent & does not pass off.

358. A 25 years female was found in room with 100%

burns on her body. The tongue was protruding out; A contercoup injury is one which is stituated on the
body was in pugilistic attitude with heat ruptures, contralateral side of the area of impact.
peeling of skin, and heat haematoma and heat - It is due to sudden stoppage of the movement of the head
by coming in contact with a hard substance on the

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 MINOR TOPICS
opposite side causing linear and more harmful rotational
strains.
TOPIC 55 : CROSS EXAMINATION
361. Leading questions are permitted only in
A. Examination in chief
B. Cross examination
C. Dying declaration
D. Re-examination
B • Depressed fracture is caused by a heavy weapon with a
..........(AIPGMEE - 1995)
Leading questions are permitted in cross-examination
of the witness by the counsel for the opposite side so as
to extract from the witness any facts which can be
favorable to the opposite side.
The objective is to weaken the evidence of the witness by
showing that his details are inaccurate /conflicting /
contradictory or that his opinion are ill-founded and
opposed to that of will recognized authorities. There is
no time limit for cross-examination.
362. All is exempted from oral testimony EXCEPT
A. Dying declaration
B. Medical evidence of injury as witness
C. Chemical examination report
D. Evidence of medical expert in lower court
B the fractured bone is depressed inwards and its shape
..........(AIIMS PGMEE NOV - 1999)
• Oral evidence or testimony is more important than
documentary evidence because it allows cross examination
for its accuracy. Therefore it is desirable that oral evidences
must always be direct and subject to cross examination.
• But there are certain exceptions when the person who
has actually witnessed the particular incident, or heard or
perceived a thing, need not himself come to court. His
report, observation or statement is accepted as such.
• These exceptions are:
1) Dying declaration *
2) Expert opinions expressed in a treatise*
3) Deposition of a medical witness taken in a lower court*
4) Report of certain government scientific experts eg.*
Chemical examiner; chief inspector of explosives, director
of finger print bureau.
5) Evidence given by a witness in a previous judicial
proceedings *
6) Statements by persons who cannot be called as witnesses
(the person is either dead, untraceable or has become
incapable of giving evidence or cannot be called without
unreasonable delay or expense to the court)
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FORENSIC MEDICINE 21
TOPIC 56 : depressed fracture
363. Depressed # of skull results from :
A. Heavy object with small striking surface
B. Heavy object with large striking surface
C. Fall over the ground
D. Light object
A
..........(PGI - June -2000)
small striking surface e.g. hammer, stick or stone :
Type of fracture indicate the type of weapon e.g. circular
depressed fracture when hammer is used, it is known as
signature fracture.
364. ‘Fracture-ala signature’ is:
A. Gutter facture
B. Depressed fracture
C. Ring fracture
D. Sutural spearation
B
..........(AIIMS PGMEE - MAY 2006)
Types of skull fracture :
a) Depressed fracture
it is caused by a heavy weapon with a small striking surface
eg. hammer.
indicates the type of weapon used, thus also k/a signature
fracture.
b) Fissured fracture (linear fracture)
its a linear fracture or crack involving the inner or outer
table or both (Inner table is more commonly fractured) it
cannot be detected on an x-ray. It can only be detected
at biopsy.
these fractures follow the path of least resistance and
are deflected from the thicker and more resistant bony
portions of the skull, such as the frontal and parietal
eminences, occipital protuberance, petrous mass and
glabella. They course down through the thinner and less
resistant bones, such as the frontal sinuses, orbital roof
and parietal and occipital squama.
c) Pond or indented fracture
these fractures are seen in children because of the
elasticity of their bones these occur due to forcible impact
against some protruding object.
d) Gutter fracture
when a bullet causes a glancing blow, it removes a part
of thickness of the skull bone resembling a gutter,
usually the inner table is also involved and shows an irregular
depressed fracture.
e) Comminuted fracture
the bone is broken into two or more pieces.
f) Penetrating fracture
its a clean cut opening due to a penetrating weapon,
such as, a dagger or a bullet.
g) Elevated fracture
it results due to blow from a moderately heavy sharp
edged weapon eg. axe, which lifts one end of the fractured
bone above the surface of skull while the other end is
depressed down in the cranial cavity injuring the underlying
brain,
 MINOR TOPICS FORENSIC MEDICINE 22

h) Ring fracture “Although Human chromosome may be visualised in any

this term is commonly used to signify any fracture around growing tissue such as bone marrow, skin, fibroblasts,
the foramen magnum. Technically, it means a fissured anmiotic fluid cells, orchorionic villus, they are most
fracture about 3.5 cms outside the foramen magnum at conveniently studied in peripheral blood Lymphocytes. “
the back, involving middle ear on sides, and root of nose
anteriorly. 368. Chromosomal defect is a feature amongst all of
its rare fracture and requires a lot of force to produce it. the following except:
it results from: A. Inter sex
i) fall from height on feet or buttoks B. Consealed sex
ii) a severe blow directed underneath the occiput or chin. C. Pseudo hermaphrodite
iii) heavy blow on vertex which drives the skull downwards D. True hermaphrodite
on the vertebral column. B
iv) a violent and sudden turn of the head on the spine. ..........(AIPGMEE - 1997)

TOPIC 57 : h2s poisoning Variations of Normal sex :

1. Genetic/Chromosomal defects- Klinefelters (XXY)
365. Blue hypostasis is seen poisoning due to: Turners (XC)
A. H2S
B. Phosphorus
C. CO
D. Organ ophosphorus compounds
E. Arsenic
A
..........(PGI - DEC 2002)

• Certain poisons impart distinct colour to hypostasis :

Carbon monoxide — bright cherry red.
Potassium cyanide — pink.
Potassium chlorate — chocolate brown.
Phosphorus — dark brown.
Nitrites — red brown.
Hydrogen sulphide (H2S) — bluish green.
Opium — almost black.
• Greyish lividity — Death due to septic abortion caused by
Cl. welchii
Cherry red lividity — death due to burning and exposrue to
cold.

366. Sewer gas Is

A. Phosgene
B. H2S
C. CO: 2. Intersex states i.e. conditions in which male & female
D. Aluminium phosphide characters coexist in varying proportions in the same
B and C individual.
..........(PGI - JUNE 2003)
Divided into 4 groups
TOPIC 58 : KARYOTYPING - Gonadal agenesis (gonads never develop)
- Gonadal dysgenesis (no gonads, external sexual structures
367. Karyotyping of foetus may be done from all of the present) e.g. Turner’s, Klinefelter’s.
following except; - True hermaphroditism (external genitalia may be of both
A. Lymphocyte sexes, internal genitalia may consist of both testes &
B. Monocyte ovaries.
C. Amniocyte - Pseudo-hermaphmditism (lack of clear cut differentiation
D. Fibroblast of external genitalia, while internal genitalia is iso-sexual)
B 3. Concealed sex —> Criminals sometimes try to conceal their
..........(AIPGMEE - 1999) sex by change of dress or other methods, Eunuchs &
Dancers may also do this.

TOPIC 59 : locard princple

369. Locard’s exchange principle is for-

A. Detecting poisoning
B. Estimating the age*
C. Finding out time since death
D. Detecting crime
D
..........(AIIMS PGMEE - MAY 1995)

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• Locard’s principle of exchange TOPIC 62 : amityptiline toxicity

• States that when two objects come in contact with each
other, there is always some transfer of material from one 375. A patient lalita present with dry mouth, pupillary
to other. dilation and warm skin, the likely drug toxicity is
A. Organo-phosphorus
370. A person comes in contact with other. This is called B. Carbamazepine
A. Locard principle C. Lithium
B. Quetlets rule D. Amytriptyline
C. Petty’s principle D
D. None of the above ..........(AIIMS PGMEE JUNE - 1999)
A
..........(AIPGMEE - 2001)
Locards principle of exchange states that when two objects
come into contact with each other, there is always some
transfer of maternal from one to the other.

TOPIC 60 : PARACETMOL POISONING

371. A female, Lalita, aged 26 yrs accidentally takes 100

tablets of paracetamol. What is treatment of choice
A. Lavage with charcoal
B. Dialysis
C. Alkaline diuresis
D. Acetyl cystein
D
..........(AIIMS PGMEE NOV - 1999)
• “In cases of moderate to severe poisoning N acetyicysteine
(Mucomyst) should be given orally. It is most effective
when given within 16-24 hours of overdosage. It prevents
hepatic damage’.
Common side effects associated wit h tricyclic
antidepressants
372. Both hepatic and renal failures can be caused by:
A. Paracetamol toxicity Sedati Anti- Hypote Cardiac Seizu Weight
B. Carbon tetra chloride on cholinergic nsion effects res gain
C. Arsenic effects
D. Copper sulfate Amitriptyli +++ +++ +++ +++ ++ ++
E. Mushrooms ne
A,B,D and E
Clomipra ++ +++ ++ +++ +++ +
..........(PGI - June -2002)
mine
TOPIC 61 : SUICIDE Desipram 0/+ + + ++ + +
ine
373. Tentative cut is a feature of Nortriptyli + + + ++ + +
A. Fall from the height ne
B. Homicidal assault
• Most Tricyclic antideprersants (Imipramine, Amitryptiline)
C. Accidental injury
are potent anticholinergics.
D. Suicidal attempt
• The symptoms shown by patient are because of
D anticholinergic effect of Amitryptyline.
..........(AIPGMEE - 2002), PGI - DEC 2004)
TOPIC 63 : atavism
Hesitation marks or Tentative cuts or Trial wounds are
multiple, small and superficial cuts often involving only
376. Atavism is resemblence of features to
the skin and are seen at the beginning of the incised
A. Mother
wound. B. Father
These are indicative of suicidal attempt. C. Neighbour
D. Grandfather
D
..........(AIIMS PGMEE JUNE - 1999)

• “In Atavism the child does not resemble its parents but
its grandparents.”

TOPIC 64 : BLOOD GROUPS

377. Which of the following statement about blood

grouping is not correct -

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 MINOR TOPICS FORENSIC MEDICINE 24

A. It can be used to resolve confusion of identity in alleged A. Carbolic acid

exchange of babies in maternity unit B. Morphine
B. It is the method to conclusively fix the paternity C. H2SO4
C. It can assist in matching fragmented human remains in D. Cannabis
mass disaster A
D. It can help to show whether blood stain on the weapon ..........(AIIMS PGMEE JUNE - 2000)
belongs to the suspect or victim
B • Carbolic acid
...........(AIIMS PGMEE - NOV 2004) • is a corrosive poison.
• It has two actions on body -one a local action & one a
The examination of a freshly drawn blood is carried out for remote action after absorption.
solving forensic problem like disputed maternity or • Local action:
paternity. • Causes necrosis and sloughing of the tissues.
Inspite of a large number of blood grouping systems a positive
conclusive identity of a father cannot be established • Causes corrosion of the lips, mouth, tongue and stomach.
but a definite non identity that is the elimination or The burnt areas are white in colour which later became
exclusion can be shown. brown*
Thus conclusive evidence cannot be provided but a significant • In postmortem the stomach looks brownish & leathery*
contribution can be made for establishing the proof of
paternity by various blood group systems and their • Remote action after absorption:
inheritance. • Strong remote action on the CNS causing its collapse and
unconsciousness
Medicolegal aspects of blood group • Skin is cold & clammy, weak pulses.
A blood group antigen cannot appear in a child unless present • Breathing stertorus & laboured because of depression of
in one or the other parents If an individual is homozygous medulla
for a blood group factor, it must appear in the blood of all • Pin point pupils*
his children.
If a child is homozygous for a blood group factor, the gene
for the same must have been inherited by him from each
of his parents.
The blood group characters are peculiar to the individual and
are unchanged throughout life.
It is by far the best defined inherited human characteristic
and therefore most useful in problems of identity.

In paternity testing an absolute identification can be made

by DNA testing
The application of blood group determination to
medicolegal problems is resorted to for the following
purposes • Carbolic acid has nephrotoxic action:
Disputed paternity and maternity • Urine contains albwnin, blood casts & metabolic products
To determine the possible source of blood stains in of carbolic acid is hydroquinone & pyrocatechol. On
circumstances such as murder, wounding, rape and exposure to air the metabolic products are oxidized
vehicular accidents. resulting in dark smoky green colour’ of urine (Carboluria)
Inheritance claims
Rh hazards • Mitotic pupils are seen in
Transfusion errors. – Carbolic acid*
– Organophosphorus*
TOPIC 65 : CANTHARIDE POISONING – Opium*
– Pontine haemorrhages*
378. Priapism occurs in: Green coloured urine —> carbolic add Poisoning
A. Snakebite Golden urine (liquid gold) —> Barbiturates
B. Ratti poisoning Brown coloured urine —> nitric acid poisoning
C. Cantharide poisoning Leathery appearance of stomach —> Carbolic acid
D. Arsenic poisoning Velvety appearance of stomach* —> Arsenic
C Brown discolouration of the stomach* — >
..........(AIIMS PGMEE - MAY 2006) Sulphuric acid

• Priapism can be seen in Cantharide and Phosphorus TOPIC 67 : entomology of cadaver

poisoning.
380. Maggots in rainy day are seen within
TOPIC 66 : CARBOLIC ACID POISONING A. 6 hours
B. 1-2 days
379. A patient with suspected poisoning has brownish C. 2-4 days
oral mucosa and tongue , constricted pupil and D. 5-6 days
greenish brown urine, poisoning is with C
…….(PGI - 1997 - Dec)

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 MINOR TOPICS FORENSIC MEDICINE 25

• Flies are attracted to the putrefying body & lay their eggs
especially in the open wounds & in moist & sheltered
natural orifices such as nose, mouth, vagina & anus by
about 18-26 hours. The eggs hatch into maggots or larvae
in about 24 hours.
So, maggots are seen after 2-4 days.
4. Heat stroke - (heat hyperpyrexia, sub stroke)
- It is due to impairment of body’ s heat regulating
mechanism caused by failure of cutaneous circulation &
sweating, following prolonged exposure to hot, humid
conditions.
- The onset is usually sudden with sudden collapse and loss
of consciousness. Predominant symptoms may also be
seen (i.e. headache, nausea, vomitting, dizziness, mental
confusion, muscle cramps, excessive thirst, excessive desire
to micturate)

- The skin is dry, hot and flushed with complete absence

of sweating
- Body temperature rises as high as 43°C (hence k/a
hyperpyrexia) when body temp , rises above 42°C
vasodilation occurs with decrease in blood volume leading
to circulatory collapse and cardiac failure.
- Delirium and convulsions may precede death.
- Mortality rate in this condition is relatively high.
TOPIC 68 : HASSE RULE - Fatal period varies from few minutes to 3 days.
381. Rule of Hasse is used to determine; TOPIC 70. KEROSENE POISONING
A. The age of fetus
B. Height of an adult 383. What is incorrect regarding Kerosene aspiration
C. Race of a person pneumonitis
D. Identification A. Induction of emesis predisposes to pneumonitis
A B. X-ray appearances precede clinical features
..........(AIIMS PGMEE NOV - 2003) C. Fever occurs in initial few hours
D. Corticosteroids are the treatment of choice
• Hasse’s rule is employed in calculating the age of D
fetus from its length ..........(AIIMS PGMEE - DEC 1994)
During the first five months of pregnancy, the length in cms
is square of the age in months i.e. Length in cms = (Age TOPIC 71 : magistate
in months)2
384. Powers of a 1st class magistrate:
During second five months of pregnancy, length in cms divided A. Fine upto Rs.5000 &3 years imprisonment.
by 5 gives the age B. Fine upto Rs. 3000
A
TOPIC 69 : HEAT STROKE ..........(PGI - JUNE 2006)

382. Sweating is Not present in Power of magistrates :

A. Heat syncope Class of magistrate Imprisonment Fine
B. Heat cramps Chief Judicial Magistrate upto 7 yrs Unlimited
C. Heat stroke I Class magistrate upto 3 yrs Rs.5000
D. Heat fatigue II Class magistrate upto 1 yr Rs. 1000
C
..........(AIIMS PGMEE - MAY 2008) TOPIC 72 : mci

Exposure to high environmental temperatures can lead
to following conditions –
1. Heat fatigue - Performance of a person decreases due
to high environmental temperatures. The person gets
tired early d/t high temp.
2. Heat cramps - these arc painful spasms of voluntary
muscles following strenous work in hot conditions. These
cramps are caused by loss of water and salt from profuse
sweating.
385. Medical qualifications awarded by institutions
outside India and recognized by MCI are registered
in:
A. First schedule of Indian Medical Council Act 1956
B. Second schedule of Indian Medical Council Act 1956
C. Part I of third schedule of Indian Medical Council Act 1956
D. Part II of third schedule of Indian Medical Council Act 1956
B
..........(AIPGMEE - 2006)

3. Heat syncope (heat exhaustion, heat collapse) TOPIC 73 : MEDICAL NEGLIGENCE

- It is a condition of collapse without increase in body
temperature, following exposure to hot and humid 386. Which is Not a medical negligence act:
atmosphere. A. 37 IPC
B. 304 A
- On examination,/ace is pale, skin cold, the temperature C. 351 IPC
subnormal D. 312 IPC
- The pt. usually recovers when placed at rest. Death is unusual C
and may occur d/t heart failure. ..........(AIIMS PGMEE - JUNE 1998)

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• Voluntarily causing grievous hurt by dangerous
weapons or means : Imprisonment for a term up to ten
years and also fine (S. 326,1.P.C.).
• ASSAULT : An assault is an offer or threat or
attempt to apply force to body of another in a
hostile manner (S. 351,1.P.C.). It may be a common
assault or with an intent to murder.
• In primary impact injuries, the site and nature of injuries
depend on the height of the pedestrian and upon the
position of the person in relation to the vehicle when
struck, i.e. whether crossing the road from one side to
the other walking with or against the traffic. The injuries
also depend upon the relative heights of various parts of
the vehicle, i.e. bumper, radiator, fenders.

• In a typical case, the victim is struck by the front of the

vehicle. An adult usually sustains injuries on the lees and
a child on the head.

• Fracture of the tibia and, fibula of one or both legs is k/a

bumper fracture.
- The fracture is usually spiral or wedge shaped. The
base of the triangular fragment of bone indicates the site
of the impact and the apex points in the direction in
which the vehicle was travelling.
TOPIC 74 : PEDESTRIAN INJURY - In a bumber fracture, the distance from the heel to
the fracture site gives information regarding height of the
387. Most common site of primary impact injury to bumper and whether brakes were applied or not.
pedestrians in a motor vehicle accident is… When brakes are applied before the accident, the legs
A. Abdoemn are injured at a lower level. (The front bumber tends to
B. Legs rise during acceleration and dip under braking.
C. Head
D. Chest • If the pedestrian is hit from the side, there may be
B unilateral fracture of the nearest leg.
..........(AIIMS PGMEE - NOV 2007)
• If the pedestrian is facing the vehicle, he may sustain
Three types of injuries are seen in pedestrians in a motor intra-abdominal injuries and/or injuries to the chest wall
vehicles injury. and thoracic contents. Sometimes the pelvis is fractured.
1. Primary impact injuries (the first part struck)
- These injuries are caused by the first impact between TOPIC 75 : perjury
the vehicle and the pedestrian.
388. Perjury means giving willful false evidence by a
witness while under oath, the witness is liable to be
prosecuted for perjury and the imprisonment amy
extend to seven years. This falls under which section
of IPC.
A. 190 of Indian Penal Code
B. 191 of Indian Penal Code
C. 192 of Indian Penal Code
D. 193 of Indian Penal Code
D
..........(AIPGMEE - 2003)

2. Secondary impact injuries (further injuries by the same

vehicle)
- These injuries are d/t subsequent impact with the same
vehicle, for eg. the pedestrian may be lifted on to the
vehicle after the initial impact

3. Secondary injuries (sometimes also called tertiary

injuries)
- These are the injuries caused d/t the victim falling on the
ground or other stationary object.

TOPIC 76 : PRENATAL DIAGNOSTIC TECHNIQUE ACT

389. In prenatal diagnostic technique Act 1994 which

one of the following is not a ground for carrying out
prenatal test?
A. Pregnant women above 35 years of age
B. History of two or more spontaneous abortion or fetal loss.

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 MINOR TOPICS FORENSIC MEDICINE 27

C. When fetal heart rate is 160 per min at fifth and 120 per • Heat Haematoma or burn haematoma occurs when the
min at ninth month. head has been exposed to intense heat, sufficient to
D. History of exposure to potentially teratogenic drugs cause charring of the skull. It has the appearances of
C extradural haemorrhage (EDH), but is not accompanied
...........(AIPGMEE - 2003) by any signs of injury by blunt force.

Pre-natal Diagnosis Techniques Regulation and prevention of
Misuse Act 1994 Primary aim: to prevent female foeticide.
Under Section 4(2) a prenatal diagnostic technique shall
be conducted only for:
Chromosomal anomalies
Genetic metabolic disease
Sex linked genetic disorders
Hemoglobinopathics
Congenital Anomalies
Any other abnormality or disease as may be specified by the
central supervisory Board.
No test should be done bv the medical personnel
except in the followine conditions
• Age of the pregnant woman above 35 yrs.
• Pregnant woman has undergone two or more spontaneous
abortions or fetal loss.
• The pregnant woman has been exposed to potentially
teratogenic agents such as drugs, radiation, infection and
chemicals.
• Pregnant woman who has a family history of mental
retardation or physical deformities such as pasticity or any
other genetic disease.
TOPIC 77 : rati seeds
• As it resembles EDH, so it is seen between skull & dura.
TOPIC 79 : SULPHURIC ACID POISONING
392. A 17 years old female patient came to emergency
one & half hour after severe H 2SO 4 poisoning with
features of hypotension, restlessness, next step is
A. Ryle’s tube intubation
B. I.V fluid sedation, monitoring
C. Gastric lavage
D. Antidote should be given
D
..........(AIIMS PGMEE JUNE - 2000)
Treatment plan of sulphuric acid poisoning include:
1) Avoid gastric lavage or emetics
2) Stomach tubes are contraindicated.
3) What should not be used Alkaline carbonates &
bicarbonates, which liberate CO2 should not be used as
they may cause gastric distention & rupture.
4) What can be used Neutralization of the acid by milk of
magnesia can be used. lime water, soap & water can also
be used later dilute demulcent drinks, such as barley water
milk, the gruel or beaten eggs may be given.

390. Sin needle used to kill animals made of :
A. Dhatura seeds
B. Rati seeds
C. Lead peroxide
D. Arsenic
B administration of corticosteroids and antibiotics patients
..........(PGI - DEC 2006)
• Rati seeds derived from plant — Abrus precatorius
(jequirity). They seeds are tasteless, odourless, oval and
red in colour, with a black spot on one pole. The active
principle is -abrain, a toxalbumin and its action resemble
to those of viperine snakebite.
• The animal are poisoned with the seeds by means of sui.
Suis are fine needles prepared by decorticating seeds an
powdering them, followed by mixing the powder with
opium, onion, dhatura and spirit or water and hardened
into needles. Needles when injected under skin or into
wound produce poisoning. Needles are 15mm size, 90-
120 mg in wt. Fatal dose 1-2 seeds, fatal period is 3-5
days.
Corticortercids are of questionable value in the treatment of
acid ingestion because they mask evidence of peritonitis
and may also increase the potential for gastric ulceration
& bleeding in contrast, patients, with signs of dysponea,
hoarseness or stridor who may benefit from immediate
with sign of to relieve airway obstruction due to mucosal
edema and bronchospasm
TOPIC 80 : tattoing
393. Blackening and tattooing of skin and clothing can
be best demonstrated by:
A. Luminol spray
B. Infrared photography
C. Ultraviolet light
D. Magnifying lens
B
..........(AIPGMEE - 2003)
“In revealing latent tatto marks, the use of infrared
photography or ultraviolet lamp may prove helpful.”

TOPIC 78 : Subdural hematoma I would not advocate spending time searching between
options of Infrared photography and ultra violet light. Infra
391. Burn (heat) haematoma is seen between: red photography is the answer of consensus.
A. Skull and dura
B. Brain and arachnoid TOPIC 81 : THANATOLOGY
C. Arachnoid and Pia
D. Pia and dura 394. Thanatology is the science that deals with :
A A. Death in all its aspects
..........(PGI - 1997 - Dec) B. Solving paternity of the child

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 MINOR TOPICS FORENSIC MEDICINE 28

C. Identification of the living

D. Detection of lie
A
..........(AIIMS PGMEE NOV - 2002) TOPICS

“Thanatology deals with death in all its aspects.” APM VS PM 4

GRIEVOUS INJURY 3
TOPIC 82 : BURNS GRIEVOUS HURT 3
GUN POWDER 2
395. Which cause of death would cause an elevated level IUD 3
of cyanide. OPIOID POISONING 5
A. Cold OPIUM 1
B. Starvation CONSENT 4
C. Thermal burns GASTRIC LAVAGE 4
D. Poisoning INQUEST 3
C MTP 4
..........(AIIMS PGMEE NOV – 2000)

• “Depending on the materials burning in the fire, various MINOR TOPICS

levels of cyanides are found in the blood”

• The burning of plastics and synthetic materials produce

cy anides & oxides of nitrogen. Cyanides produced
contributes to death in thermal burn.

• The presence of carbon particles in the terminal

bronchioles on histological examination is absolute
proof of life during the fire.

• The soot is better seen by spreading a thin film of mucus

on a clean sheet of white paper. The amount of soot in
the air-passages depends on the type of fire, the amount
of smoke produced and the duration of survival in the
smoke-contaminated atmosphere. Presence of carbon
particles and an elevated CQ saturation together are
absolute proof that the victim was alive when the time
occurred.

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